A new study from the Johns Hopkins Bloomberg School of Public Health found automated phone calls were far more effective than Facebook ads in getting Baltimore City residents to request a smoke alarm through the city's free installation program.

By the end of a campaign that ran in 2014, four hundred and fifty-eight participants who'd received an automated phone call offering free smoke alarm installation requested one versus 25 participants who had seen a Facebook ad about the same smoke alarm campaign.

The findings, published May 17, 2018 in the Journal of Public Health Management and Practice, highlight the challenges of using social media to promote safety initiatives at a time when land line use is dramatically declining. In the past 15 years, the number of households with land lines has dropped from 90 to 40 percent. In contrast, nearly 70 percent of U.S. adults use social media.

Smoke alarms are known to reduce the risk of death by at least half and, like several other U.S. cities, Baltimore offers free smoke alarms to residents in an effort to prevent residential fire injuries and deaths. In Maryland, Baltimore City consistently has the highest fire death, more than double the national rate in 2015.

"Don't disconnect your landline yet," says Shannon Frattaroli, PhD, associate professor in the Bloomberg School's Department of Health Policy and Management and the paper's lead author. "What might be considered old fashioned ways are perhaps are still quite effective. A low cost initiative to reach out with automated calls from Baltimore's fire chief went a long way toward getting people to adopt the behavior we wanted."

For the study, the research team worked with the Baltimore City Fire Department to create a campaign encouraging residents to participate in the free smoke alarm program. Working with the Fire Department, the campaign included a series of Facebook ads targeted to city residents as well as automated phone calls to approximately 90,000 households with a recorded message from Fire Chief Niles Ford about the smoke alarm installation service.

Three Facebook advertisements were disseminated during October 2014 and included three different images and the message, "Fires act fast. You should too. Protect your family now." The ads included a information about how to connect with the Fire Department to arrange an installation visit. The advertisement was sent to Facebook newsfeeds and mobile newsfeeds of a sample of Baltimore City residents over the age of 18. In total, the ads received 465,666 impressions and reached 128,339 unique users. 99.9 percent of those who viewed the ad did so on a mobile device and the campaign resulted in 6,075 click-throughs to the City's website with information about how to contact the Baltimore City Fire Department.

"Facebook was very effective in putting that message out there," says Frattaroli, who is the associate director for outreach at the Johns Hopkins Center for Injury Research and Policy based at the Bloomberg School. "What we didn't see was those messages being converted into actions."

The automated phone call was disseminated to approximately 90,000 numbers, but researchers were unable to capture how many people actually heard the call.

Upon completion of the messaging campaign, researchers worked with Baltimore City's 311 service–the phone number and website through which the Fire Department receives smoke alarm installation requests–to track and analyze how requesters learned about the smoke alarm service. 946 requests for smoke alarm installations were made through 311 during October 2014 and, of those, 458 cited the prerecorded phone calls from the Chief as their information source. Only 25 cited Facebook.

With landline use declining, researchers say this could impact how public health messages are spread, received, and acted upon. "The enormous reach that the Facebook ads had really did allow this fire prevention message to get into the feeds, onto the phones and desktops of consumers in a short period of time. What was surprising was the lack of conversion of that exposure to the message," Frattaroli says. As consumer habits change–and the ways that they engage with their communities change–public health professionals will need to adapt to learn how to effectively leverage the communication tools people are using.